Childhood and Nutrition (Mela) Bab7b

7/29/2019 Childhood and Nutrition (Mela) Bab7b

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SCHOOL YEARS : AGES 5 TO 10INFLUENCES ON NUTRITION IN CHILDHOOD

CHILDHOOD DIET AND HEALTHUNDERNUTRITION IN CHILDHOOD

PLANNING A HEALTHY CHILDHOOD DIET

CHILDHOOD AND NUTRITION


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School Lunch Programs BenefitProviding nutritious foodProvide education in nutrition healthy foodchoices

Parents and children involved in menu planningProviding school lunches offering several foodchoices, programs can increase variety & allowstudent to participate in a healthy diet.

Children tend to have higher nutrition intake & eatgreat variety of foodsChildren shows improvement in learning

Programs are now encouraged to keep salt & sugar content at moderatelevels & reduce fat & cholesterol levels AHA recommendation


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EATING PATTERNS IN OLDERCHILDREN

Appetite & food preferences are more predicrableIncreasing activity steady appetiteDifferences intake male & female : male eat more

protein & micronutrients than femaleFat intake : 35-40 % of total cal, sugar : 25 % cal(USDA 1987)

BREAKFA

ST-Breakfast rebuilds glycogen stores depleted during the night andprovide energy-10-30 % school aged children do not eat breakfast

-Reasons :Not hungry, have no time, dont like food served, the foods they


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INFLUENCES ON NUTRITION INCHILDHOOD

Evening meal: time for family interaction and socializing School aged children should help prepare in the meal plan & food

preparation Mealtime criticism is not allowed reduce intake of certain vitamin

especially vit A & C Parents should continue halthy eating habits carry into later life

influence long-term health

PARENTALINFLUENC

ES

TV affects children attitudes toward food and food preferences Advertisements Excessive TV viewing : sedentary lifestyle and may contribute to obesity The risk of obesity correlate with the amount TV watched everyday (Dietz and

Gortmaker, 1985) Higher cholesterol levels

THEIMPACT OF

TV ONCHILDHOO

D

NUTRITION

Families and schools encouragechildren to develop active, imaginativesSo,

how?


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INDONESIA PMT ASKemendiknas Renstra 2010-2014 : PMT AnakSekolahPendekatan penyediaan makanan tambahandilakukan dengan cara memberikan makanantambahan dengan kandungan minimal 300 kilokalori dan 5 gram protein yang diberikansebanyak 108 kali dalam satu tahun ajaran.Pendekatan pendidikan kesehatan dan gizidilakukan secara formal, informal dan non formal.Program lain : UNICEF bkj sama dg Indomartmengumpulkan dana utk penanggulangan gizianak


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Behavioral changes may cause by : lack of sleep,lack of physical activity, emotional state, desire for attention, anxiety, or other factors--- NUTRITIONALFACTORS IS ALSO


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SWEETENERS No convincing evidence that refinedsugar or aspartame cause behavioralproblems

ARTIFICIAL FLAVORS & COLORS -Feingold Diet 1970-Double blind study--- found no benefit-Small number of ADHD may benefit-Short term elimination- observe therespond - if no improvement, childrenshould resume normal diet

CAFFEINE Over children consume caffeine :

chocolate, ice cream, carbonated beverageEffects : inattentive, restless, difficultysleeping, irregular heartbeats


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VITAMIN & MINERALSUPPLEMENTATION

Use of vitamin & mineral suppl among school-aged children is extensive (Kover 1985)

AAP 1993 : doesnt recommend routine suppl for healthy childrenFluoride suppl is indicated for certain areas wheredrinking water contain less fluorideSuppl only for children with special conditions

(TABEL 7.14 PAGE 421)


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VEGETARIAN DIETBENEFIT : plan-based diets supplemented withmilk or eggs and milk similar nutritionally todiets containing meats; children raised on wellbalance vegetarian diets have demonstratedexcellent health.

rarity of obesitylower blood pressure


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VEGETARIAN DIET- NEGATIVEEFFECTS

May not provide adequate iron risk iron def anemia- Energy density of many vegan diet are low (ADA, 1988)

Inadequate energy or protein failure to growVegan children tend to be smaller

These diets are bulky young children may not able toconsume adequate volume of food

Lack of calcium, zinc and iron for growing children; high inphytates inhibit the absorbtion of nutrient


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SOLUTIONS FOR CHILDREN WITH VEGANDIET

DIETARY IRON --- eat ample nuts, seeds andlegumes, in addition to milk and eggsPlants protein must properly combined to ensurethe adequate intake of Amino Acids for growthIntake of vegetable oils and fortified soy milkGenerous intake of unrefined cereals, legumes,seeds, and dark green leafy vegetables --- to

avoid def Ca, Fe, ZnFortified margarines to provide additional vit D AAP recommend the inclusion of multivitaminsuppl with iron and vit B12


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DENTAL HEALTHDiet is also important in the prevention of dentalcaries. Plaque on the tooth surface containsseveral strains of bacteria able to break downdietary sugar produce lactic acid dissolvesthe enamel, leads to cavity formation progress

the cavity will deepen and allow bacteria toinvade the dental pulp, causing infection, swellingand pain.


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DENTAL HEALTHTooth decay occurs when a susceptible tooth isexpposed to cariogenic bacteria & sugar Cariogenic sugar : sucrose, glucose, maltose,lactose, & fructose

Reducing the number of times sugar is introducedinto the mouth will reduce the acid challenge to theenamelRestrict the sugar intake is important

Protective factors against caries : fats and proteinFats can coat the teeth, reducing the cariogenicbacteria to produce acids, rduce the retention andcariogenicity of sugar

Protein : increases the buffering capacity of the


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DIETARY FAT ANDCHOLESTEROL

Atherosclerosis appears to begin early in life andprogress in life and progress slowly into adulthood.Elevated cholesterol levels in childhood role in theinitiation and development of atherosclerosis, andhigh total and LDL-cholesterol are correlated with the

extent of early atherosclerosis in adolescents.Experts have recommended a strategy that combines2 complementary approach :

1. Population-wide reduction in fat and cholesterol in thediets of all children

2. An individual approach aimed at identifying andtreating children who are at greatest risk of havinghigh blood cholesterol and an increased risk of cardiovascular disease in later life


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The guidelines for individual screening of childrenonly for children who have a parent whosecholesterol level is greater than 240 mg/dl, or afamily history of early ( less than 55 years of age)

heart disease.Children who have an elevated LDL-cholesterolAHA Step-One diet 3 months careful

adherence to this diet fail to achieve goal AHAStep-Two Diet under qualified supervisionbecause this diet requires stringent reduction of saturated fat and cholesterol intake ( saturatedfatty acids : less than 7% of total calories;cholesterol less than 200 mg/dl ) careful

planning to ensure adequate intake of allnecessar nutrients.


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There have been concerns about safety of implementing a lower-fat diet during childhood.Reducing fat intake while maintaining normal caloriesand protein will not lead to deficiencies of iron andcalcium or other micronutrients.

Another controversy surrounding cholesterol levels inchildhood is whether high levels during childhoodpredict elevated levels in later life.

A growing consensus of experts recommends the AHA Step-One Diet for children over 2 years old and

adolescents. Many think if this diet could be adoptedduring childhood and carried into adulthood, it wouldreduce the incidence of cardiovascular disease andmay prevent a variety of other chronic conditions anddisease of later life.


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FOOD ALLERGIES INCHILDHOOD

Early childhood is a common age for food allergies occur in 2 - 15 % of young children , particularly with familyhistory of allergy.Environmental factors during infancy and exposure toantigens in early infancy may increase the risk of developing food allergies.Food allergies occur when dietary proteins areincompletely broken down before absorption, allowinglarge molecules of protein to enter the body and interactwith the immune system. The immune cells identify the

food molecule as an antigen and react by producingantibodies, histamine and other defensive compounds, andcause a variety of symptoms including anaphylacticreactions to food.Food allergies occur more often in early childhood than

later in life because the developing intestinal tract andimmune system are immature and inexperienced in


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Allergy to single foods is much common than tomultiple foods, can be immediate or delayed up to 24hours.The preferred way to test for food allergy

elimination diet.Food that most often provokes allergies are eggs,peanuts, fish and milk in 77% of cases; beef, pork,shellfish, peas, cocoa beans, hazelnuts, mustard in

12,8% of cases; and chicken, rabbit, garlic, soybeans,sunflower, carrots, almonds, peaches, bakers yeastand wheat four in 10,2% of cases.Children often grow out of food allergies. A study in

1987 found that over of children no longer reactedto the foods they had been allergic to previously.


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LEAD POISONINGIn the US, elevated levels of lead in the blood are amajor health risk for children-- decrease intellectualperformance and produce other adverse healtheffects.

through contaminated soil and water, LEAD PIPES,DISHES, ACIDIC FLUIDS

A primary source of lead exposure, particularly onurban areas, is lead-based paints: eating paint chips,

dust, dirtChildren absorb more lead and are more sensitive toits effects than adults. Lead is absorbed anddistributed much like calcium. Deficiencies in protein,

iron or calcium enhance the absorption of lead andmay increase its toxic effects in children.


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interferes with cellular enzymes and metabolismslow growth, damage hearing, and impair coordination and balancechronic lead intoxication may be listless andirritablelow levels of lead exposure in childhood canimpair neuropsychological development and

classroom performance. AAP now recommends : lead screening whenthey are 9 12 months old and again at 2 years.


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Iron deficiencyIn many developing countries, a mostly cereal dietwith little meat, fish and ascorbic acid is low inbioavailable ironIntestinal parasites are common as a frequent causeof increased blood loss and iron deficiency

Iron deficiency may cause anemia, decreasedperformance and impaired mental and motor development, have poor appetites, more likely todevelop infections, and grow more slowly than their healthy counterparts

Iron deficiency anemia is rare before 4 to 6 months of age, because the healthy infant has ample iron storesat birthIron deficiency develops between 6 months 3 yearsif increased needs for rapid growth are not met by and

adequate dietary supply. AAP recommendation : children up to age 3 should


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Undernutrition in Children

Causes : Poverty, economic, social, cultural andeducational factors contribute to the problemWeaning an infant at an early age without anutritious replacement for breast milkInfections are a major contributor to morbidity andmortality in the malnourished child--- diare malabsorbtion

UNDERNUTRITION growth retardation,decreased resistance to infection and disease,impaired learning ability, and increased mortality,contributing cause in 1/3 of all child deaths

worldwide.


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PROTEIN ENERGYMALNUTRITION

MILD - mildest and most common form of PEM is growth failure alone.-Growth impairment, most often seen in the post-weaning period from 9 months 3 years of age--Mild PEM in children increases the risk of infections(DIARRHEA, measles),mortality--functional impairment and diminished work capacity in adult life.

SEVERE -Kwashiorkor occurs when a child consumes a diet with adequate energy but with a verylow protein : energy ratio.-Children -- will not grow, and they develop anorexia, diarrhea, and characteristic hair and skin changes, edema is a hallmark of kwashiorkor, Subcutaneous fat may bepreserved and, with edema, may mask the wasting of underlying tissue-- Severe muscle wasting often result in the childs being unable to stand or walk. -MARASMUS : form of severe PEM caused by starvation-inadequate intake of energy,protein and other nutrients results in a shrunken, wasted child. Body weight is less than60% of expected weight for age.-MARASMUS :severely anemic, suffer from chronic infections, and have a high mortality.


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More often than either syndrome alone, severelymalnourished children develop characteristics of both kwashiorkor and marasmus.The term marasmic kwashiorkor is used for children who are less than 60% of expectedweight and have edema and other signs of kwashiorkor.Treatment for severe PEM consists of providingadequate amounts of both calories and proteinand treating intercurrent infections


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MICRONUTRIENTDEFICIENCIES

1 often associated with protein-energy malnutrition significant adverse effects on growth, learning

ability, and the immune system.

2 micronutrient deficiencies, particularly of vitamin A and iron, play major roles in childhood stunting

in certain developing countries

3 micronutrient deficiencies were associated with

widespread retardation of cognitive, motor andpsychosocial development in children.


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VIT A DEFICIENCYXeropthalmia : damage to the eyes from lack of vitamin ADeficiency also impairs immunity : increasesusceptibility to infection, increase mortalityHIGH RISK :- Preschool-age children (1-6 years old) are mostsusceptible to vitamin A deficiency

- Diets that are mainly vegetarian, with staplesuch as rice or cassava, and that lack dark greenvegetables and yellow fruits, will be deficient invitamin A.

Strategies for preventing deficiency involve modification of diets to include :more sources of vitamin A, food fortification ( such as sugar in Central

America and monosodium glutamate in southeast Asia), and distribution of

high doses of the vitamin to young children every three to six months.


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IODINE DEFICIENCYHIGH RISK GROUP :- areas where the soil and water, and thereforethe food produced on it, are low in iodine- adequate iodine in the diet, but the food supplycontains substances that inhibit iodine absorptionand metabolism (goitrogens), include cassava,soybeans and cabbages.

- young children and pregnant women, wheniodine requirements are highTwo most common syndromes are goiter andcretinism


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The effects of iodine deficiency are particularlysevere for the fetus and growing child.Iodine deficiency associated with neurological

damage, impaired mental function and retardedphysical development.The most widely used and effective means of controlling iodine deficiency are fortification of saltwith iodine and widespread oral or injectedadministration of iodinated oil.


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MASALAH GIZI ANAKINDONESIA

RISKESDAS 2010 :14 % balita gizi lebih>15 tahun prevalensi obesitas : 19,1 %

tidak ada perbedaan prevalensi balita gizi lebih padakeluarga termiskin (13.7%) dan keluarga terkaya(14.0%)prevalensi balita gizi kurang 19,9 %

35,7 % anak Indonesia tergolong pendekPROGRAM PENANGGULANGAN MALNUTRISI ANAK :- PMT AS, DETEKSI ANEMIA PADA ANAK SEKOLAH- PENYULUHAN, KADARZI, UPGK

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Childhood and Nutrition (Mela) Bab7b